Nutrition and ageing Screening for malnutrition in dwelling elderly Antoni Salva` 1,2, * and Guillem Pera 3 1 Programa Vida Als Anys, A ` rea Sanita` ria, Servei Catala` de la Salut, Travessera de les Corts 131–159, E-08028 Barcelona, Spain: 2 Hospital Sant Jaume, Mataro´ , Spain: 3 Unitat de Recerca de la Fundacio´ del Consorci Sanitari del Maresme ‘Doctor Jaume Esperalba i Terrades’, Mataro´, Spain Abstract The health of elderly people is often affected by inadequate nutritional intake. Psychosocial determinants and the higher prevalence of acute and chronic illnesses are risk factors for nutritional deficiencies in the elderly. Nutritional assessment (NA) or nutritional risk screening must be an important element in care programmes for elderly people in the community and should be part of all geriatric assessment programmes. Keywords Screening Malnutrition Elderly Studies on dietary intake of the elderly population show an average decrease in the intake of most nutrients with age. The recommended energy intake for the Spanish population aged over 70 years is 1700 kcal day 21 for women and 2100 kcal day 21 for men. According to recent nutritional surveys in Spain, above 25% of the non- institutionalised aged population shows intakes lower than the reference values 1–4 . The percentage of people with inadequate intakes is considerably higher among people with functional dependence and greater co- morbidity. Elderly people who live in good health in the community show low rates of undernutrition. In the SENECA study in Betanzos, Spain 1 , none of the subjects was found to have serum albumin level below 30 g l 21 and only 3% had a body mass index (BMI) lower than 20 kg m 22 . However, inadequate intakes for vitamin B 6 and B 12 , carotenes, vitamin D and folic acid were found. In the Nutrition Survey of the Catalan population 2 , only 2.6% in the age group 65–75 years had a BMI lower than 20 kg m 22 . In a study in Mataro´ (Catalun˜a) on a random sample of self-dependent people, only 1.5% had BMI values below 21 kg m 22 and 5% lower than 23 kg m 22 (unpublished data). In the same population group, using the Mini Nutitional Assessment (MNA) as the evaluation method, only 0.5% were classified in the undernutrition group and 9.5% had nutritional risk criteria 5 . Studying ill people with moderate to high levels of dependency for daily life activities (DLA), the percentage of undernutri- tion is much more important. In a study carried out in Canada on dependent people, Payette et al. 6 found that 40% of men and 32% of women were underweight. Undernutrition rates among the institutionalised elderly show high variability in different studies, ranging from 15 to 60% depending on the method used and characteristics of the subjects studied 7–9 . Risk factors for malnutrition in elderly people Different situations and factors can lead to decreased intake and undernutrition. They can be classified into two main groups 10 , as follows. Problems related to the environment In the Mataro´ study, 48.7% of people under 70 years of age were able to do their shopping independently, but this figure decreased to 22% for people over 80 years. Although 55% of this group of elderly people had some help in preparing their meals, 20.1% of over 65’s and 31.6% of those over 80 years used to eat alone 4 . People living alone or eating alone usually eat less than people of the same age sharing their meals with others. They also tend to choose easy-to-prepare meals and to limit the range of different foods, thus increasing the chance for nutrient deficiencies. Poor presentation, poorly adapted or tasteless preparations are some other factors to be considered. Finally, restrictive diets can also cause a decrease in intake. Physical or psychological problems The use of chronic pharmacological treatments and polypharmacy increase the risk of interactions between drugs and nutrients. Among others, it is noteworthy to mention delayed drug absorption (iron salts, tetracycline, amoxycillin, ampicilline, cephalosporins, calcium, flufe- nacin, haloperidol); increased absorption of the drug (diazepam, lithium salts); and interference in nutrient Public Health Nutrition: 4(6A), 1375–1378 DOI: 10.1079/PHN2001222 *Corresponding author: Email 18581asc@comb.es q The Authors 2001 https://doi.org/10.1079/PHN2001222 Published online by Cambridge University Press